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At peace : choosing a good death after a long life
\"The authoritative, informative, and practical follow up to BEING MORTAL, on end-of-life care for patients over the age of 65. Most people say they would like to die quietly at home. But overly aggressive medical advice, coupled with an unrealistic sense of invincibility, results in the majority of elderly patients misguidedly dying in institutions while undergoing painful procedures, instead of having the better and more peaceful death they desired. At Peace outlines specific active and passive steps that older patients and their health care proxies can take to insure loved ones pass their last days comfortably at home and/or in hospice, when further aggressive care is inappropriate. Through Dr. Harrington's own experience with his parents and patients, he describes the terminal patterns of the six most common chronic diseases; how to recognize a terminal diagnosis even when the doctor is not clear about it; how to have the hard conversation about end-of-life wishes; how to minimize painful treatments; when to seek hospice care; and how to deal with dementia and other special issues. Informed by more than thirty years of clinical practice, Dr. Harrington came to understand that the American health care system wasn't designed to treat the aging population with care and compassion. His work as a hospice trustee and later as a hospital trustee informed his passion for helping patients make appropriate end-of-life decisions\"-- Provided by publisher.
Book
Stroke-Related Anxiety, Depression and Quality of Life Among Iraqi Patients with Stroke: A Cross-Sectional Multi-Hospital Study
Stroke affects patients' physical, psychological, and social well-being, with many survivors suffering anxiety, depression, and a decline in quality of life (QOL). These problems remain underexplored among Middle Eastern populations.
This study aimed to assess levels of stroke-related anxiety, depression, and QOL, as well as to determine their associated factors and predictors among Iraqi patients with stroke.
A cross-sectional descriptive correlational design was used, employing the Stroke-Specific Quality of Life (SS-QOL) scale and Hospital Anxiety and Depression Scale on 200 Iraqi stroke survivors.
The sample consisted of middle-aged and older adults, with a mean age of 58.3 years and 42% of participants aged 65 or above; 52.5% were male. Clinically significant levels of anxiety and depression were reported, with a mean score of 12.2 (SD = 3.4) for anxiety, and 11.46 (SD = 3.45) for depression. Higher risk was observed in older, unmarried, unemployed patients and those in early or intermediate stages since stroke onset. Levels of QOL poorly declined poststroke and were below the theoretical mid-range levels of SS-QOL, with mean SS-QOL = 82.6 (SD = 30.2; range = 49-129). Predictor variables of poor QOL included advanced age (
= -0.647,
< .001), unmarried status (
= -5.85,
< .01), hypertension (
= -4.73,
< .05), early post-stroke stage vs chronic (
= -19.8,
< .001), intermediate vs chronic stage (
= -11.3,
< .001), and clinically significant levels of anxiety (
= -6.61,
< .01) and depression (
= -23.6,
< .001). Together, these predictors explained 87% of the variance in QOL (adjusted
= .874,
(18,181) = 77.5,
< .001). Severe depression emerged as the strongest predictor, accounting for 31% of variance (
(181) = -23.6,
< .001; sr
= .310).
Iraqi stroke survivors experience severe levels of anxiety and depression, consistent with poor QOL, and are influenced by socio-demographic and clinical factors. Early assessment and targeted management of high-risk groups by healthcare providers should be considered with the objective of optimizing recovery and rehabilitation. Depression is of great clinical importance due to its significant impact on QOL.
Journal Article
Finishing our story : preparing for the end of life
\"Death is the destiny we all share, and this will not change. Yet the way we die, which had remained the same for many generations, has changed drastically in a relatively short time for those in developed countries with access to healthcare. For generations, if people were lucky enough to reach old age, not having died in infancy or childhood, in childbirth, in war, or by accident, they would take to bed, surrounded by loved ones who cared for them, and fade into death. Most likely, they would have seen their parents and grandparents die the same way, and so this manner of dying would be familiar: it was part of the natural cycle of life. Now less than 25 per cent of Americans die at home, having reached much older ages than people would have dreamed of in past generations, often after surviving many illnesses and even diseases that would have been terminal for their grandparents. We are fortunate to live (and die) today, supported by myriad scientific, medical, and technological advancements, however we also face new problems as a result of the new way in which we die. We can no longer anticipate a peaceful waning at home with family. We know our lives will likely end in hospitals likely after we have endured grueling treatments to prolong life. We have to decide what decisions we want our loved ones, or care-givers, to make when we cannot choose for ourselves. We have to think about whether in any circumstances we would seek physician-assisted death. We know we face other questions as well, but we may not even know where to start. In the face of these decisions, we can feel daunted and afraid. The best remedy is information and planning. In this book, Gregory Eastwood - a physician who has cared for dying patients, served as an ethics consultant, and taught end of life issues to medical and other health profession students - draws from his substantial experience with patients and families to provide the information that will help us think clearly about the choices and issues we will face at the end of our own lives, and when faced with the deaths of our loved ones. With sensitivity and profound insight, Eastwood guides us through all the important questions about death and dying in straightforward, clear language, enhanced by real-life stories. Throughout, he shows us how we can take ownership of the way we want to die, when we must die, and feel more in control as death approaches. \"-- Provided by publisher.
Book